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（六）肾小管损伤的其他实验室指标尿β2</sub>-微球蛋白及尿N-乙酰-β-D-葡萄糖苷酶（NAG）增高，尿渗透压降低提示肾盂肾炎。 | [
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{
"id": 1,
"entity": "尿β2</sub>-微球蛋白",
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"end_offset": 30,
"label": "ite"
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{
"id": 2,
"entity": "尿N-乙酰-β-D-葡萄糖苷酶",
"start_offset": 31,
"end_offset":... |
（七）影像学检查1.B超检查可探查泌尿系的结构和膀胱排泄功能有无异常，有无结石、梗阻及残余尿等引起感染诱因。 | [
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{
"id": 1,
"entity": "B超检查",
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"label": "pro"
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{
"id": 2,
"entity": "泌尿系",
"start_offset": 17,
"end_offset": 20,
"label": "bod... |
2.X线检查静脉肾盂造影可显示泌尿系统有无先天畸形（如重肾和多囊肾等）、肾盂积水及其程度。 | [
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"entity": "X线检查",
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{
"id": 1,
"entity": "静脉肾盂造影",
"start_offset": 6,
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"label": "pro"
},
{
"id": 2,
"entity": "泌尿系统",
"start_offset": 15,
"end_offset": 19,
"label": "bo... |
了解肾的大小，有无肾盂肾盏变形等慢性炎症和肾疤痕证据。 | [
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"entity": "肾",
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{
"id": 1,
"entity": "肾盂肾盏",
"start_offset": 9,
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"label": "bod"
},
{
"id": 2,
"entity": "肾盂肾盏变形",
"start_offset": 9,
"end_offset": 15,
"label": "sym"
... |
3.核素检查同位素锝-99m二巯基丁二酸（99mTc-dimercaptosuccinicacid，DMSA）肾静态显像可作为上尿路感染诊断的可靠指标，对发现肾盂肾炎的敏感性和特异性均在90%以上。 | [
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"id": 1,
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{
"id": 2,
"entity": "肾盂肾炎",
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"end_offset": 83,
"label": "di... |
当急性肾盂肾炎时肾的轮廓正常，由于肾实质的炎性细胞浸润，肾间质水肿及肾小管细胞坏死致DMSA减少，造成病变部位同位素分布的稀疏区，当炎症消散后此种稀疏区可消失。 | [
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"id": 0,
"entity": "急性肾盂肾炎",
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{
"id": 1,
"entity": "肾实质的炎性细胞浸润",
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"label": "sym"
},
{
"id": 2,
"entity": "肾间质水肿",
"start_offset": 28,
"end_offset": 33,
"lab... |
在慢性肾盂肾炎，肾疤痕形成时，病变部位的DMSA摄入更少，且肾外形可因疤痕收缩而缩小或见楔形缺损区。 | [
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"id": 0,
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"label": "dis"
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{
"id": 1,
"entity": "肾疤痕",
"start_offset": 8,
"end_offset": 11,
"label": "dis"
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{
"id": 2,
"entity": "病变部位的DMSA摄入更少",
"start_offset": 15,
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"lab... |
【诊断和鉴别诊断】患者多有感染或尿路刺激的临床症状，结合尿常规及尿培养菌落计数可以做出诊断。 | [
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{
"id": 1,
"entity": "尿路刺激",
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{
"id": 2,
"entity": "尿常规",
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1.清洁中段尿，离心镜检中WBC≥5/HP，或有尿感症状；2.中段尿培养菌落计数≥105</sup>/ml；3.如无1条，应再做中段尿培养，同一细菌仍≥105</sup>/ml，可确诊。 | [
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"entity": "离心镜检",
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{
"id": 1,
"entity": "离心镜检中WBC≥5/HP",
"start_offset": 8,
"end_offset": 21,
"label": "sym"
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{
"id": 2,
"entity": "尿感症状",
"start_offset": 24,
"end_offset": 28,
"lab... |
可称无症状性菌尿。 | [
{
"id": 0,
"entity": "无症状性菌尿",
"start_offset": 2,
"end_offset": 8,
"label": "dis"
}
] |
尿培养是确定诊断的重要证据，要求在抗生素应用前做，排尿前勿多饮水。 | [
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"entity": "尿培养",
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{
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留尿过程中要严格按常规操作，以免尿液污染。 | [
{
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"entity": "尿液",
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] |
尿白细胞管型、血白细胞总数和中性粒细胞比例增高，血沉增快，C反应蛋白升高，提示肾盂肾炎，影像学DMSA检查，确认肾盂肾炎的存在，并了解炎症的范围和程度。 | [
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{
"id": 1,
"entity": "血白细胞",
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"label": "bod"
},
{
"id": 2,
"entity": "中性粒细胞",
"start_offset": 14,
"end_offset": 19,
"label": "bod... |
不伴泌尿道结构或/和功能异常的尿感为单纯性尿感；伴结构或/和功能异常的尿感为复杂性尿感，后者容易复发或反复感染，造成高血压和慢性肾衰竭的后果。 | [
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{
"id": 1,
"entity": "不伴泌尿道结构或/和功能异常",
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"label": "sym"
},
{
"id": 2,
"entity": "尿感",
"start_offset": 15,
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"label"... |
急性肾盂肾炎严重者可合并败血症，特别是在新生儿和有阻塞性肾病者，故有明显感染中毒症状及血白细胞20×10<sup>9</sup>～25×10<sup>9</sup>/L的患者，血培养。 | [
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{
"id": 1,
"entity": "败血症",
"start_offset": 12,
"end_offset": 15,
"label": "dis"
},
{
"id": 2,
"entity": "阻塞性肾病",
"start_offset": 25,
"end_offset": 30,
"label": "d... |
对一般抗菌治疗无效应和尿细菌培养多次无细菌生长的尿感，尚应结合胸片、OT试验、尿沉渣找抗酸杆菌、结核培养和静脉肾盂造影等除外泌尿系结核。 | [
{
"id": 0,
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"end_offset": 7,
"label": "pro"
},
{
"id": 1,
"entity": "尿细菌培养",
"start_offset": 11,
"end_offset": 16,
"label": "ite"
},
{
"id": 2,
"entity": "尿细菌培养多次无细菌生长",
"start_offset": 11,
"end_offset": 23,
"lab... |
经驱虫，加强外阴护理和局部处理可缓解症状，不必口服抗菌药。 | [
{
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（二）抗感染治疗1.药物选择细菌性尿感根据尿感的定位诊断及病原选药：①上尿路感染选用血和肾浓度高的药物，下尿路感染选用尿浓度高的药物；②根据检查的病原菌及其药物敏感试验选药；③尽可能用低毒的药物。 | [
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{
"id": 1,
"entity": "细菌性尿感",
"start_offset": 14,
"end_offset": 19,
"label": "dis"
},
{
"id": 2,
"entity": "尿感",
"start_offset": 21,
"end_offset": 23,
"label": "dis... |
婴幼儿应采取积极有效的治疗，如伴有呕吐及精神萎靡者，建议静脉用药。 | [
{
"id": 0,
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{
"id": 1,
"entity": "精神萎靡",
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"label": "sym"
},
{
"id": 2,
"entity": "静脉用药",
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"end_offset": 32,
"label": "pro... |
头孢类抗生素，特别是第二、三代头孢菌素，有较好的效果，因氨苄西林耐药菌株有增多趋势，已有被安美汀（羟氨苄西林+β内酰胺酶抑制剂克拉维酸）替代趋势。 | [
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"id": 0,
"entity": "头孢类抗生素",
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{
"id": 1,
"entity": "第二、三代头孢菌素",
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"label": "dru"
},
{
"id": 2,
"entity": "氨苄西林耐药菌株",
"start_offset": 28,
"end_offset": 36,
"l... |
氨基糖苷类静脉滴注要慎用，时间不可长。 | [
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"id": 0,
"entity": "氨基糖苷类静脉滴注",
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"end_offset": 9,
"label": "pro"
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] |
喹诺酮类药物抗菌作用较强，但7岁以下小儿慎用。 | [
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"entity": "喹诺酮类药物",
"start_offset": 0,
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] |
SMZco和呋喃妥因适用于下尿路感染的治疗，一般用药5～7日。 | [
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{
"id": 1,
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"label": "dru"
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{
"id": 2,
"entity": "下尿路感染",
"start_offset": 13,
"end_offset": 18,
"label": "dis"... |
对真菌引起的尿路感染可用抗真菌药。 | [
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{
"id": 1,
"entity": "抗真菌药",
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"label": "dru"
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] |
2.疗程由于儿童膀胱炎和肾盂肾炎临床上不易区分，新生儿和小婴儿尿路感染合并畸形的比例较高，短程疗法，包括单剂量疗法和3天疗法，在儿童中均不宜推广。 | [
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"entity": "儿童膀胱炎",
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"label": "dis"
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"id": 1,
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"end_offset": 16,
"label": "dis"
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{
"id": 2,
"entity": "新生儿和小婴儿尿路感染合并畸形",
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"end_offset": 39,
... |
采用短程疗法的急性尿路感染儿童，其复发率和重新感染的机会均大于2周左右的常规疗法。 | [
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{
"id": 1,
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"label": "dis"
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] |
只有年龄大于5岁，尿路没有畸形，才考虑采用短程疗法。 | [
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{
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},
{
"id": 2,
"entity": "短程疗法",
"start_offset": 21,
"end_offset": 25,
"label": "pro... |
急性初次上尿路感染经有效抗菌治疗，多于2～3日高热渐降，尿常规迅速恢复正常，常规疗程为2周。 | [
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"entity": "抗菌治疗",
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{
"id": 2,
"entity": "多于2～3日高热渐降",
"start_offset": 17,
"end_offset": 27,
"l... |
对治疗恢复不顺利者应根据尿培养及药敏试验及时更换抗生素，疗程需4～6周。 | [
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{
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},
{
"id": 2,
"entity": "抗生素",
"start_offset": 24,
"end_offset": 27,
"label": "dru... |
初次尿感痊愈后第1、2、3、6、12个月应随访中段尿培养及菌落计数至少1年。 | [
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{
"id": 1,
"entity": "中段尿培养",
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"label": "ite"
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{
"id": 2,
"entity": "菌落计数",
"start_offset": 29,
"end_offset": 33,
"label": "ite"... |
3.复发和再感染的治疗急性尿路感染经合理抗菌治疗，多数于数日内症状消失、治愈，但有50%的患儿可有复发，多在治疗后1个月内出现。 | [
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"entity": "感染",
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"end_offset": 8,
"label": "dis"
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{
"id": 1,
"entity": "急性尿路感染",
"start_offset": 11,
"end_offset": 17,
"label": "dis"
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{
"id": 2,
"entity": "合理抗菌治疗",
"start_offset": 18,
"end_offset": 24,
"label": "p... |
常见的原因有：①抗菌药物选择不当，包括未选用针对致病菌敏感的药物和仅选用了肾组织内浓度低的药物，因而达不到有效的杀菌目的。 | [
{
"id": 0,
"entity": "致病菌",
"start_offset": 24,
"end_offset": 27,
"label": "mic"
},
{
"id": 1,
"entity": "肾组织",
"start_offset": 37,
"end_offset": 40,
"label": "bod"
}
] |
②出现了耐药菌株，这在初次感染的病人很少见，如初次治疗后72小时症状和菌尿未消失，应及时按药敏结果更换抗生素。 | [
{
"id": 0,
"entity": "耐药菌株",
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"end_offset": 8,
"label": "mic"
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{
"id": 1,
"entity": "感染",
"start_offset": 13,
"end_offset": 15,
"label": "dis"
},
{
"id": 2,
"entity": "72小时症状和菌尿未消失",
"start_offset": 28,
"end_offset": 40,
"label"... |
③L-型细菌，占肾盂肾炎复发的20%，根据其仅能在肾髓质高渗条件下生存，可通过多饮水来降低肾髓质渗透压破坏其生存环境，同时选用红霉素和氯霉素等抑制蛋白质合成的药物重新治疗。 | [
{
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"entity": "L-型细菌",
"start_offset": 1,
"end_offset": 6,
"label": "mic"
},
{
"id": 1,
"entity": "肾盂肾炎",
"start_offset": 8,
"end_offset": 12,
"label": "dis"
},
{
"id": 2,
"entity": "肾髓质",
"start_offset": 25,
"end_offset": 28,
"label": "bod"... |
④尿路结石。 | [
{
"id": 0,
"entity": "尿路结石",
"start_offset": 1,
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"label": "dis"
}
] |
尿路结石的存在可为细菌提供有效的庇护所，逃脱抗菌药物的杀灭作用而得以幸存，常在治疗中止后，成为复发的病因。 | [
{
"id": 0,
"entity": "尿路结石",
"start_offset": 0,
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"label": "dis"
},
{
"id": 1,
"entity": "细菌",
"start_offset": 9,
"end_offset": 11,
"label": "mic"
}
] |
⑤病原菌除大肠杆菌外，变形杆菌是最常见的致病菌。 | [
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"entity": "病原菌",
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{
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{
"id": 2,
"entity": "变形杆菌",
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... |
在1岁以上的男童，初次感染的致病菌也以变形杆菌为主。 | [
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{
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{
"id": 2,
"entity": "变形杆菌",
"start_offset": 19,
"end_offset": 23,
"label": "mic"... |
对这些病人应按药敏选用抗生素，剂量要大，疗程要长，至少在6周以上。 | [
{
"id": 0,
"entity": "抗生素",
"start_offset": 11,
"end_offset": 14,
"label": "dru"
}
] |
⑥如菌尿持续存在或经2次6周以上治疗仍频繁复发，则要选用长程低剂量抑菌疗法，以每晚睡前一次顿服为宜，剂量为常规治疗量的1/3～1/4，药物可选用SMZ+TMP、阿莫西林、头孢氨苄或呋喃妥因等，或两种交替使用，以防产生耐药菌株。 | [
{
"id": 0,
"entity": "菌尿持续存在",
"start_offset": 2,
"end_offset": 8,
"label": "sym"
},
{
"id": 1,
"entity": "经2次6周以上治疗仍频繁复发",
"start_offset": 9,
"end_offset": 23,
"label": "sym"
},
{
"id": 2,
"entity": "长程低剂量抑菌疗法",
"start_offset": 28,
"end_offset": 37,
... |
再感染多发生在初次治疗后1个月以上，常见于女童，占再发性尿路感染的80%。 | [
{
"id": 0,
"entity": "感染",
"start_offset": 1,
"end_offset": 3,
"label": "dis"
},
{
"id": 1,
"entity": "再发性尿路感染",
"start_offset": 25,
"end_offset": 32,
"label": "dis"
}
] |
再感染均为不同菌株或同一菌株不同血清型的大肠杆菌所引起，常合并有尿路梗阻和膀胱输尿管反流等尿路畸形。 | [
{
"id": 0,
"entity": "感染",
"start_offset": 1,
"end_offset": 3,
"label": "dis"
},
{
"id": 1,
"entity": "大肠杆菌",
"start_offset": 20,
"end_offset": 24,
"label": "mic"
},
{
"id": 2,
"entity": "尿路梗阻",
"start_offset": 32,
"end_offset": 36,
"label": "dis"
... |
再感染的病人，应首先采用10～14天的常规治疗，如症状和菌尿消失，继之以小剂量抗生素预防重新感染，可供选择的药物有SMZ+TMP、呋喃妥因、阿莫西林或头孢氨苄等，剂量为常规治疗量的1/5～1/4。 | [
{
"id": 0,
"entity": "感染",
"start_offset": 1,
"end_offset": 3,
"label": "dis"
},
{
"id": 1,
"entity": "抗生素",
"start_offset": 39,
"end_offset": 42,
"label": "dru"
},
{
"id": 2,
"entity": "重新感染",
"start_offset": 44,
"end_offset": 48,
"label": "dis"
... |
如10～14天的常规治疗无效，应延长疗程至6周，有效者继续以小剂量抗生素预防，无效者或当时有效但随后再感染频发，宜选用长程低剂量抑菌疗法，方法同上，疗程至少1年以上，如确诊有尿路畸形，则需用至畸形被矫正或膀胱输尿管反流自行中止后1年为止。 | [
{
"id": 0,
"entity": "小剂量抗生素预防",
"start_offset": 30,
"end_offset": 38,
"label": "pro"
},
{
"id": 1,
"entity": "无效者或当时有效但随后再感染频发",
"start_offset": 39,
"end_offset": 55,
"label": "sym"
},
{
"id": 2,
"entity": "长程低剂量抑菌疗法",
"start_offset": 59,
"end_offset"... |
4.无症状性菌尿的治疗无症状性菌尿大多不需治疗，因为抗菌治疗并不能降低再感染的发生率。 | [
{
"id": 0,
"entity": "无症状性菌尿",
"start_offset": 2,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "无症状性菌尿",
"start_offset": 11,
"end_offset": 17,
"label": "dis"
},
{
"id": 2,
"entity": "抗菌治疗",
"start_offset": 26,
"end_offset": 30,
"label": ... |
不过，如果患儿合并有尿路梗阻、膀胱输尿管反流等尿路畸形，或继往感染留下肾内陈旧性疤痕，则应给予积极治疗。 | [
{
"id": 0,
"entity": "尿路梗阻",
"start_offset": 10,
"end_offset": 14,
"label": "dis"
},
{
"id": 1,
"entity": "膀胱输尿管反流",
"start_offset": 15,
"end_offset": 22,
"label": "dis"
},
{
"id": 2,
"entity": "尿路畸形",
"start_offset": 23,
"end_offset": 27,
"label":... |
否则，菌尿及并存畸形可促进旧疤痕的发展和新疤痕的形成，导致肾脏功能受损，肾性高血压形成，直至终末期肾衰竭。 | [
{
"id": 0,
"entity": "菌尿及并存畸形",
"start_offset": 3,
"end_offset": 10,
"label": "sym"
},
{
"id": 1,
"entity": "疤痕",
"start_offset": 14,
"end_offset": 16,
"label": "dis"
},
{
"id": 2,
"entity": "疤痕",
"start_offset": 21,
"end_offset": 23,
"label": "dis... |
无症状菌尿的治疗，先采用10～14天常规疗法，菌尿转阴后，给予小剂量长期预防，药物选择、剂量和疗程与再感染病人的预防相同。 | [
{
"id": 0,
"entity": "无症状菌尿",
"start_offset": 0,
"end_offset": 5,
"label": "dis"
},
{
"id": 1,
"entity": "10～14天常规疗法",
"start_offset": 12,
"end_offset": 22,
"label": "pro"
},
{
"id": 2,
"entity": "菌尿转阴后，给予小剂量长期预防，药物选择、剂量和疗程与再感染病人的预防相同",
"start_offset": 23,... |
5.慢性肾盂肾炎的治疗慢性肾盂肾炎常有肾皮质疤痕形成，并伴有肾乳头和肾盂肾盏的变形扩张，或持续的肾功能损害和肾脏挛缩。 | [
{
"id": 0,
"entity": "慢性肾盂肾炎",
"start_offset": 2,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "慢性肾盂肾炎",
"start_offset": 11,
"end_offset": 17,
"label": "dis"
},
{
"id": 2,
"entity": "肾皮质疤痕",
"start_offset": 19,
"end_offset": 24,
"label":... |
慢性肾盂肾炎大多伴有膀胱输尿管反流，少数有尿路梗阻，不伴畸形者极少见。 | [
{
"id": 0,
"entity": "慢性肾盂肾炎",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "膀胱输尿管",
"start_offset": 10,
"end_offset": 15,
"label": "bod"
},
{
"id": 2,
"entity": "膀胱输尿管反流",
"start_offset": 10,
"end_offset": 17,
"label"... |
慢性肾盂肾炎的治疗包括内科保守治疗和外科治疗。 | [
{
"id": 0,
"entity": "慢性肾盂肾炎",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "内科保守治疗",
"start_offset": 11,
"end_offset": 17,
"label": "pro"
},
{
"id": 2,
"entity": "外科治疗",
"start_offset": 18,
"end_offset": 22,
"label": ... |
对于有尿路畸形者或尿路梗阻者，应尽早手术。 | [
{
"id": 0,
"entity": "尿路畸形",
"start_offset": 3,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "尿路梗阻",
"start_offset": 9,
"end_offset": 13,
"label": "dis"
}
] |
6.尿路畸形的治疗输尿管肾盂连接处狭窄或肾结石引起的肾盂积水，后尿道瓣膜和膀胱输尿管反流Ⅲ级以上应予手术治疗。 | [
{
"id": 0,
"entity": "尿路畸形",
"start_offset": 2,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "输尿管",
"start_offset": 9,
"end_offset": 12,
"label": "bod"
},
{
"id": 2,
"entity": "输尿管肾盂连接处狭窄",
"start_offset": 9,
"end_offset": 19,
"label": "... |
【预后】对于大多数慢性尿路感染患儿，随着尿路畸形的矫正和积极的抗感染治疗，尿路感染急性发作的次数可明显降低，肾疤痕形成的风险减少。 | [
{
"id": 0,
"entity": "慢性尿路感染",
"start_offset": 9,
"end_offset": 15,
"label": "dis"
},
{
"id": 1,
"entity": "尿路畸形的矫正",
"start_offset": 20,
"end_offset": 27,
"label": "pro"
},
{
"id": 2,
"entity": "积极的抗感染治疗",
"start_offset": 28,
"end_offset": 36,
"la... |
仅少数起病年龄早，就诊时已有广泛肾疤痕形成的慢性尿路感染的小儿，会发展成高血压，进行性肾损害，直到慢性肾衰竭。 | [
{
"id": 0,
"entity": "广泛肾疤痕形成",
"start_offset": 14,
"end_offset": 21,
"label": "sym"
},
{
"id": 1,
"entity": "慢性尿路感染",
"start_offset": 22,
"end_offset": 28,
"label": "dis"
},
{
"id": 2,
"entity": "高血压",
"start_offset": 36,
"end_offset": 39,
"label"... |
所以，对儿童，尤其婴幼儿的尿路感染要引起足够的重视。 | [
{
"id": 0,
"entity": "尿路感染",
"start_offset": 13,
"end_offset": 17,
"label": "dis"
}
] |
三、治疗（一）氧疗对于呼吸功能不全者，吸入低-中浓度氧（FiO<sub>2</sub>0.3～0.5）数小时，可以提高血氧饱和度（SpO<sub>2</sub>＞90%），一般认为有效。 | [
{
"id": 0,
"entity": "氧疗",
"start_offset": 8,
"end_offset": 10,
"label": "pro"
},
{
"id": 1,
"entity": "呼吸功能不全",
"start_offset": 12,
"end_offset": 18,
"label": "dis"
},
{
"id": 2,
"entity": "低-中浓度氧",
"start_offset": 22,
"end_offset": 28,
"label": "... |
呼吸衰竭患者吸入氧12～24小时，可以解除低氧血症，发绀和呼吸困难逐渐消退。 | [
{
"id": 0,
"entity": "呼吸衰竭",
"start_offset": 0,
"end_offset": 4,
"label": "dis"
},
{
"id": 1,
"entity": "氧",
"start_offset": 8,
"end_offset": 9,
"label": "dru"
},
{
"id": 2,
"entity": "低氧血症",
"start_offset": 21,
"end_offset": 25,
"label": "dis"
}... |
长时间吸入低浓度氧一般不会产生严重不良反应。 | [
{
"id": 0,
"entity": "氧",
"start_offset": 8,
"end_offset": 9,
"label": "dru"
},
{
"id": 1,
"entity": "严重不良反应",
"start_offset": 15,
"end_offset": 21,
"label": "sym"
}
] |
但吸入氧＞0.8，24～48小时可以导致气道炎症和水肿，甚至严重的气道黏膜过氧化损伤。 | [
{
"id": 0,
"entity": "吸入氧",
"start_offset": 1,
"end_offset": 4,
"label": "pro"
},
{
"id": 1,
"entity": "炎症",
"start_offset": 22,
"end_offset": 24,
"label": "dis"
},
{
"id": 2,
"entity": "水肿",
"start_offset": 25,
"end_offset": 27,
"label": "dis"
}... |
血氧水平过高，可以导致视网膜病变。 | [
{
"id": 0,
"entity": "血氧水平",
"start_offset": 0,
"end_offset": 4,
"label": "ite"
},
{
"id": 1,
"entity": "视网膜",
"start_offset": 11,
"end_offset": 14,
"label": "bod"
}
] |
动脉氧水平的提高必须和缺氧症状的改善相联系，因组织摄取氧的能力受到氧解离曲线、血红蛋白水平、心输出量等因素影响。 | [
{
"id": 0,
"entity": "动脉氧水平",
"start_offset": 0,
"end_offset": 5,
"label": "ite"
},
{
"id": 1,
"entity": "缺氧",
"start_offset": 11,
"end_offset": 13,
"label": "sym"
},
{
"id": 2,
"entity": "氧解离曲线",
"start_offset": 33,
"end_offset": 38,
"label": "ite... |
（二）气道管理保持呼吸道湿化和雾化，防止气道上皮细胞过于干燥而变性坏死。 | [
{
"id": 0,
"entity": "气道",
"start_offset": 3,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "呼吸道",
"start_offset": 9,
"end_offset": 12,
"label": "bod"
},
{
"id": 2,
"entity": "气道上皮细胞",
"start_offset": 20,
"end_offset": 26,
"label": "bod"
... |
清除气道分泌物可以采用拍背、气道雾化等方法，也可以使用沐舒坦等药物化痰。 | [
{
"id": 0,
"entity": "拍背",
"start_offset": 11,
"end_offset": 13,
"label": "pro"
},
{
"id": 1,
"entity": "气道雾化",
"start_offset": 14,
"end_offset": 18,
"label": "pro"
},
{
"id": 2,
"entity": "沐舒坦",
"start_offset": 27,
"end_offset": 30,
"label": "dru"... |
对于先天性或获得性气道发育导致通气障碍者，或二氧化碳潴留者，应给予气道插管、机械通气和必要的手术处理，目的为解除气道阻塞、修复窦道等先天性畸形。 | [
{
"id": 0,
"entity": "气道",
"start_offset": 9,
"end_offset": 11,
"label": "bod"
},
{
"id": 1,
"entity": "通气障碍",
"start_offset": 15,
"end_offset": 19,
"label": "sym"
},
{
"id": 2,
"entity": "二氧化碳潴留",
"start_offset": 22,
"end_offset": 28,
"label": "sy... |
气道插管后应每隔1～2小时向气道滴入生理盐水，然后行负压气道吸引。 | [
{
"id": 0,
"entity": "气道插管",
"start_offset": 0,
"end_offset": 4,
"label": "pro"
},
{
"id": 1,
"entity": "气道",
"start_offset": 14,
"end_offset": 16,
"label": "bod"
},
{
"id": 2,
"entity": "生理盐水",
"start_offset": 18,
"end_offset": 22,
"label": "dru"
... |
（三）机械通气1.一般参数设置原则调节潮气和通气频率，保持通气量相对稳定，控制PaCO<sub>2</sub>在4.7～6kPa（35～45mmHg）。 | [
{
"id": 0,
"entity": "机械通气",
"start_offset": 3,
"end_offset": 7,
"label": "pro"
},
{
"id": 1,
"entity": "潮气",
"start_offset": 19,
"end_offset": 21,
"label": "ite"
},
{
"id": 2,
"entity": "通气频率",
"start_offset": 22,
"end_offset": 26,
"label": "ite"
... |
新生儿和小于3个月的婴儿通气频率40～50次/分，幼儿为30～50次/分，儿童为20～40次/分。 | [
{
"id": 0,
"entity": "通气频率",
"start_offset": 12,
"end_offset": 16,
"label": "ite"
}
] |
容量控制或压力控制时的通气潮气量在6ml/kg体重。 | [
{
"id": 0,
"entity": "通气潮气量",
"start_offset": 11,
"end_offset": 16,
"label": "ite"
}
] |
2.机械通气效果判断对于肺泡通气量与血氧合状况是否合适，采用以下公式可以判断潜在通气和换气效率：a/A（PO<sub>2</sub>）=PaO<sub>2</sub>/PAO2</sub>，其中PAO2</sub>=FiO2</sub>×（PB-PH<sub>2</sub>O）-PaCO<sub>2</sub>/R，PAO<sub>2</sub>为肺泡气氧分压，PB为海平面大气压（760mmHg），PH<sub>2</sub>O为肺泡气水蒸发分压（47mmHg），R为呼吸商（0.8）。 | [
{
"id": 0,
"entity": "机械通气",
"start_offset": 2,
"end_offset": 6,
"label": "pro"
}
] |
如果a/A＞0.5，正常或轻度呼吸功能不全；a/A＜0.5，呼吸衰竭或严重呼吸功能不全；a/A＜0.3，严重呼吸衰竭，可以有呼吸窘迫。 | [
{
"id": 0,
"entity": "正常或轻度呼吸功能不全",
"start_offset": 10,
"end_offset": 21,
"label": "dis"
},
{
"id": 1,
"entity": "呼吸衰竭",
"start_offset": 30,
"end_offset": 34,
"label": "dis"
},
{
"id": 2,
"entity": "严重呼吸功能不全",
"start_offset": 35,
"end_offset": 43,
... |
表8-27肺泡通气和血气参数的关系3.过度通气目前不主张采用过度通气的方法，因可能导致新生儿和婴幼儿脑血流显著下降，诱发缺血缺氧性脑损伤。 | [
{
"id": 0,
"entity": "通气",
"start_offset": 21,
"end_offset": 23,
"label": "pro"
},
{
"id": 1,
"entity": "通气",
"start_offset": 32,
"end_offset": 34,
"label": "pro"
},
{
"id": 2,
"entity": "脑",
"start_offset": 50,
"end_offset": 51,
"label": "bod"
}... |
对于通气效果不佳者，可以容许存在一定程度的高碳酸血症，即PaCO2</sub>能够保持在7～9kPa（50～65mmHg），而不必调高通气潮气量和气道峰压。 | [
{
"id": 0,
"entity": "通气",
"start_offset": 2,
"end_offset": 4,
"label": "pro"
},
{
"id": 1,
"entity": "高碳酸血症",
"start_offset": 21,
"end_offset": 26,
"label": "dis"
},
{
"id": 2,
"entity": "PaCO2",
"start_offset": 28,
"end_offset": 33,
"label": "ite... |
（四）呼吸兴奋剂对于中枢性急性呼吸衰竭，可以使用尼可刹米（可拉明）、盐酸洛贝林（山梗菜碱）等药物兴奋呼吸中枢，但疗效不持久，使用时必须确定气道通畅，新生儿一般不用。 | [
{
"id": 0,
"entity": "呼吸兴奋剂",
"start_offset": 3,
"end_offset": 8,
"label": "dru"
},
{
"id": 1,
"entity": "中枢性急性呼吸衰竭",
"start_offset": 10,
"end_offset": 19,
"label": "dis"
},
{
"id": 2,
"entity": "尼可刹米",
"start_offset": 24,
"end_offset": 28,
"label"... |
尼可刹米肌内、皮下或静脉注射，小于6个月75mg/次，1～3岁125mg/次，4～7岁175mg/次。 | [
{
"id": 0,
"entity": "尼可刹米",
"start_offset": 0,
"end_offset": 4,
"label": "dru"
},
{
"id": 1,
"entity": "肌内",
"start_offset": 4,
"end_offset": 6,
"label": "bod"
},
{
"id": 2,
"entity": "皮下",
"start_offset": 7,
"end_offset": 9,
"label": "bod"
},
... |
盐酸洛贝林皮下或肌内1～3mg/次，静脉注射0.3～3mg/次，必要时间隔30分钟可重复使用。 | [
{
"id": 0,
"entity": "盐酸洛贝林",
"start_offset": 0,
"end_offset": 5,
"label": "dru"
},
{
"id": 1,
"entity": "皮下",
"start_offset": 5,
"end_offset": 7,
"label": "bod"
},
{
"id": 2,
"entity": "肌内",
"start_offset": 8,
"end_offset": 10,
"label": "bod"
},... |
（五）降低颅内压遇有脑水肿时，原则上采用“边脱边补”的方式，控制出入液量，达到轻度脱水程度。 | [
{
"id": 0,
"entity": "脑水肿",
"start_offset": 10,
"end_offset": 13,
"label": "dis"
},
{
"id": 1,
"entity": "“边脱边补”",
"start_offset": 20,
"end_offset": 26,
"label": "pro"
},
{
"id": 2,
"entity": "轻度脱水",
"start_offset": 39,
"end_offset": 43,
"label": "... |
常用药为甘露醇，静脉推注每次0.25～0.5g/kg，间隔4～6小时重复应用。 | [
{
"id": 0,
"entity": "甘露醇",
"start_offset": 4,
"end_offset": 7,
"label": "dru"
},
{
"id": 1,
"entity": "静脉推注",
"start_offset": 8,
"end_offset": 12,
"label": "pro"
}
] |
一般用药后20分钟颅内压开始下降。 | [
{
"id": 0,
"entity": "颅内压开始下降",
"start_offset": 9,
"end_offset": 16,
"label": "sym"
}
] |
或采用甘露醇-复方甘油（0.5～1.0g/kg）交替应用，间隔4～6小时，直至症状缓解可逐渐停药。 | [
{
"id": 0,
"entity": "甘露醇-复方甘油",
"start_offset": 3,
"end_offset": 11,
"label": "dru"
}
] |
利尿剂多采用呋塞米，肌内或静脉注射，每次1～2mg/kg，新生儿应间隔12～24小时脱水、低血压、低血钠、低血钾、低血氯、低血钙等。 | [
{
"id": 0,
"entity": "利尿剂",
"start_offset": 0,
"end_offset": 3,
"label": "dru"
},
{
"id": 1,
"entity": "呋塞米",
"start_offset": 6,
"end_offset": 9,
"label": "dru"
},
{
"id": 2,
"entity": "肌内",
"start_offset": 10,
"end_offset": 12,
"label": "bod"
},... |
已经存在水、盐电解质紊乱者应注意及时纠正。 | [
{
"id": 0,
"entity": "水、盐电解质紊乱",
"start_offset": 4,
"end_offset": 12,
"label": "dis"
}
] |
（六）纠正酸中毒1.呼吸性酸中毒呼吸衰竭时的主要代谢失衡是呼吸性酸中毒。 | [
{
"id": 0,
"entity": "纠正酸中毒",
"start_offset": 3,
"end_offset": 8,
"label": "pro"
},
{
"id": 1,
"entity": "呼吸性酸中毒",
"start_offset": 10,
"end_offset": 16,
"label": "dis"
},
{
"id": 2,
"entity": "呼吸衰竭",
"start_offset": 16,
"end_offset": 20,
"label": "... |
一般应保持气道通畅，兴奋呼吸，必要时采用机械通气方式，降低组织和循环血中的二氧化碳。 | [
{
"id": 0,
"entity": "保持气道通畅",
"start_offset": 3,
"end_offset": 9,
"label": "pro"
},
{
"id": 1,
"entity": "机械通气",
"start_offset": 20,
"end_offset": 24,
"label": "pro"
},
{
"id": 2,
"entity": "组织",
"start_offset": 29,
"end_offset": 31,
"label": "bod... |
2.代谢性酸中毒采用碱性药物，如碳酸氢钠，通过中和体内固定酸，提高血浆，纠正酸中毒。 | [
{
"id": 0,
"entity": "代谢性酸中毒",
"start_offset": 2,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "碱性药物",
"start_offset": 10,
"end_offset": 14,
"label": "dru"
},
{
"id": 2,
"entity": "碳酸氢钠",
"start_offset": 16,
"end_offset": 20,
"label": "d... |
此外，酸中毒可以刺激气道痉挛和降低支气管扩张剂的作用，碳酸氢钠可以缓解支气管痉挛。 | [
{
"id": 0,
"entity": "酸中毒",
"start_offset": 3,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "气道",
"start_offset": 10,
"end_offset": 12,
"label": "bod"
},
{
"id": 2,
"entity": "支气管扩张剂",
"start_offset": 17,
"end_offset": 23,
"label": "dru"... |
低氧和酸中毒可以导致心肌麻痹及肺内小血管痉挛，补充碳酸氢钠可以起强心和舒张肺内血管作用，有利于改善肺内血液灌流。 | [
{
"id": 0,
"entity": "酸中毒",
"start_offset": 3,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "心肌",
"start_offset": 10,
"end_offset": 12,
"label": "bod"
},
{
"id": 2,
"entity": "心肌麻痹",
"start_offset": 10,
"end_offset": 14,
"label": "sym"
... |
一般应用5%碳酸氢钠，首剂可用1～1.5mmol/kg（1ml=0.6mmol）。 | [
{
"id": 0,
"entity": "碳酸氢钠",
"start_offset": 6,
"end_offset": 10,
"label": "dru"
}
] |
静脉滴注或慢推注时，可以将5%碳酸氢钠用乳酸-林格液或葡萄糖生理盐水稀释（1∶2vol/vol），以降低碱性液对静脉血管的刺激。 | [
{
"id": 0,
"entity": "静脉滴注",
"start_offset": 0,
"end_offset": 4,
"label": "pro"
},
{
"id": 1,
"entity": "慢推注",
"start_offset": 5,
"end_offset": 8,
"label": "pro"
},
{
"id": 2,
"entity": "碳酸氢钠",
"start_offset": 15,
"end_offset": 19,
"label": "dru"
... |
如果补充碱性液过快，或没有及时改善通气和外周循环，可能产生代谢性碱中毒，可以导致昏迷和心跳停止。 | [
{
"id": 0,
"entity": "碱性液",
"start_offset": 4,
"end_offset": 7,
"label": "dru"
},
{
"id": 1,
"entity": "代谢性碱中毒",
"start_offset": 29,
"end_offset": 35,
"label": "dis"
},
{
"id": 2,
"entity": "昏迷",
"start_offset": 40,
"end_offset": 42,
"label": "sym"... |
在出现代谢性碱中毒时，可以迅速适当降低通气量产生呼吸性酸中毒、补充生理盐水，或给予口服氯化氨、静脉注射或口服氯化钾纠正。 | [
{
"id": 0,
"entity": "代谢性碱中毒",
"start_offset": 3,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "适当降低通气量",
"start_offset": 15,
"end_offset": 22,
"label": "pro"
},
{
"id": 2,
"entity": "呼吸性酸中毒",
"start_offset": 24,
"end_offset": 30,
"label... |
（七）强心药和血管活性药的应用在持续低氧血症并发心力衰竭时可以使用洋地黄制剂、利尿剂、血管张力调节制剂等。 | [
{
"id": 0,
"entity": "强心药",
"start_offset": 3,
"end_offset": 6,
"label": "dru"
},
{
"id": 1,
"entity": "血管活性药",
"start_offset": 7,
"end_offset": 12,
"label": "dru"
},
{
"id": 2,
"entity": "低氧血症",
"start_offset": 18,
"end_offset": 22,
"label": "dis"... |
1.毛花苷丙和地高辛在呼吸衰竭时心肌缺氧，容易导致洋地黄中毒，应考虑减少其用量。 | [
{
"id": 0,
"entity": "毛花苷丙",
"start_offset": 2,
"end_offset": 6,
"label": "dru"
},
{
"id": 1,
"entity": "地高辛",
"start_offset": 7,
"end_offset": 10,
"label": "dru"
},
{
"id": 2,
"entity": "呼吸衰竭",
"start_offset": 11,
"end_offset": 15,
"label": "dis"
... |
2.多巴胺和多巴酚丁胺兴奋心脏β<sub>1</sub>受体，扩张肾、脑、肺血管作用，增加肾血流量和尿量，为休克和难治性心力衰竭的主要药物。 | [
{
"id": 0,
"entity": "多巴胺",
"start_offset": 2,
"end_offset": 5,
"label": "dru"
},
{
"id": 1,
"entity": "多巴酚丁胺",
"start_offset": 6,
"end_offset": 11,
"label": "dru"
},
{
"id": 2,
"entity": "心脏β<sub>1</sub>受体",
"start_offset": 13,
"end_offset": 30,
"... |
其半衰期非常短，必须连续静脉滴注。 | [
{
"id": 0,
"entity": "连续静脉滴注",
"start_offset": 10,
"end_offset": 16,
"label": "pro"
}
] |
多巴胺2～10μg/（kg•min），多巴酚丁胺2～20μg/（kg•min），可以联合应用，从低剂量开始。 | [
{
"id": 0,
"entity": "多巴胺",
"start_offset": 0,
"end_offset": 3,
"label": "dru"
},
{
"id": 1,
"entity": "多巴酚丁胺",
"start_offset": 19,
"end_offset": 24,
"label": "dru"
},
{
"id": 2,
"entity": "联合应用",
"start_offset": 42,
"end_offset": 46,
"label": "pro... |
3.酚妥拉明为α受体阻滞剂，可以直接扩张外周小动脉和毛细血管，显著降低周围血管阻力及心脏后负荷，提高心输出量。 | [
{
"id": 0,
"entity": "酚妥拉明",
"start_offset": 2,
"end_offset": 6,
"label": "dru"
},
{
"id": 1,
"entity": "α受体阻滞剂",
"start_offset": 7,
"end_offset": 13,
"label": "dru"
},
{
"id": 2,
"entity": "外周小动脉",
"start_offset": 20,
"end_offset": 25,
"label": "b... |
适用于低氧引起的肺血管痉挛、重症肺炎、急性肺水肿、充血性心力衰竭等疾病时的呼吸衰竭。 | [
{
"id": 0,
"entity": "肺血管",
"start_offset": 8,
"end_offset": 11,
"label": "bod"
},
{
"id": 1,
"entity": "肺血管痉挛",
"start_offset": 8,
"end_offset": 13,
"label": "sym"
},
{
"id": 2,
"entity": "重症肺炎",
"start_offset": 14,
"end_offset": 18,
"label": "dis... |
剂量为静脉滴注0.1～0.3mg/次，用5%葡萄糖盐水稀释，每分钟2～6μg速度滴入。 | [
{
"id": 0,
"entity": "静脉滴注",
"start_offset": 3,
"end_offset": 7,
"label": "pro"
},
{
"id": 1,
"entity": "葡萄糖盐水",
"start_offset": 22,
"end_offset": 27,
"label": "dru"
}
] |
应用中注意纠正低血压和心律失常，在伴有中毒性休克时应补充血容量。 | [
{
"id": 0,
"entity": "低血压",
"start_offset": 7,
"end_offset": 10,
"label": "dis"
},
{
"id": 1,
"entity": "心律失常",
"start_offset": 11,
"end_offset": 15,
"label": "dis"
},
{
"id": 2,
"entity": "中毒性休克",
"start_offset": 19,
"end_offset": 24,
"label": "di... |
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